I 

115TH CONGRESS 

1ST SESSION H. R. 4256 

To amend the Public Health Service Act to authorize the expansion of 

activities related to Alzheimer’s disease, cognitive decline, and brain 

health under the Alzheimer’s Disease and Healthy Aging Program, and 

for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 6, 2017 

Mr. GUTHRIE (for himself, Mr. TONKO, Ms. MAXINE WATERS of California, 

and Mr. SMITH of New Jersey) introduced the following bill; which was 

referred to the Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to authorize the 

expansion of activities related to Alzheimer’s disease, cognitive decline, and brain health under the Alzheimer’s 

Disease and Healthy Aging Program, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Building Our Largest 

5 Dementia Infrastructure for Alzheimer’s Act’’ or the 

6 ‘‘BOLD Infrastructure for Alzheimer’s Act’’. 


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1 SEC. 2. FINDINGS. 

2 Congress finds as follows: 

3 (1) According to former Surgeon General and 

4 Director of the Centers for Disease Control and Pre5 vention, Dr. David Satcher, ‘‘Alzheimer’s is the most 

6 under-recognized threat to public health in the 21st 

7 century.’’. 

8 (2) Deaths from Alzheimer’s disease increased 

9 55 percent between 1999 and 2014 in the United 

10 States, according to data from the Centers for Dis11 ease Control and Prevention. 

12 (3) More than 5,000,000 people in the United 

13 States are living with Alzheimer’s disease and, with14 out significant efforts to change the current trajec15 tory, as many as 16,000,000 people in the United 

16 States will have Alzheimer’s disease by 2050. This 

17 explosive growth will cause costs associated with Alz18 heimer’s disease to increase from an estimated 

19 $259,000,000,000 in 2017 to more than 

20 $1,100,000,000,000 in 2050 (in 2017 dollars). 

21 (4) Among individuals living with Alzheimer’s 

22 disease and other dementias, evidence indicates as 

23 many as 50 percent have not been diagnosed. 

24 Among individuals diagnosed with Alzheimer’s dis25 ease, only 33 percent are aware of the diagnosis. 

26 Early detection and diagnosis of Alzheimer’s disease 


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1 and other dementias allow people to access available 

2 treatments, build a care team, participate in support 

3 services, and enroll in clinical trials. Early detection 

4 can help physicians better manage a patient’s co5 morbid conditions and avoid prescribing medications 

6 that may worsen cognition or function. 

7 (5) Among individuals living with Alzheimer’s 

8 disease and other dementias, 25.3 percent experience 

9 a preventable hospitalization, and such preventable 

10 hospitalizations cost the Medicare program nearly 

11 $2,600,000,000 in 2013. 

12 (6) African Americans are about 2 times more 

13 likely than White Americans to have Alzheimer’s dis14 ease and other dementias. Hispanics are about one 

15 and one-half times more likely than White Ameri16 cans to have Alzheimer’s disease and other demen17 tias. 

18 (7) In 2016, 15,900,000 family members and 

19 friends provided 18,200,000,000 hours of unpaid 

20 care to individuals with Alzheimer’s disease and 

21 other dementias, at an economic value of over 

22 $230,000,000,000. The physical and emotional im23 pact of caregiving of individuals with Alzheimer’s 

24 disease and other dementia resulted in an estimated 


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1 $10,900,000,000 in increased caregiver health costs 

2 in 2016. 

3 (8) Strategy 4.B of the ‘‘National Plan to Ad4 dress Alzheimer’s Disease: 2017 Update’’ of the Of5 fice of the Assistant Secretary for Planning and 

6 Evaluation of the Department of Health and Human 

7 Services is to ‘‘work with State, Tribal, and local 

8 governments to improve coordination and identify 

9 model initiatives to advance Alzheimer’s disease 

10 awareness and readiness across the Government.’’. 

11 SEC. 3. PROMOTION OF PUBLIC HEALTH KNOWLEDGE AND 

12 AWARENESS OF ALZHEIMER’S DISEASE, COG13 NITIVE DECLINE, AND BRAIN HEALTH UNDER 

14 THE ALZHEIMER’S DISEASE AND HEALTHY 

15 AGING PROGRAM. 

16 Part P of title III of the Public Health Service Act 

17 (42 U.S.C. 280g et seq.) is amended by adding at the end 

18 the following: 

19 ‘‘SEC. 399V–7. PROMOTION OF PUBLIC HEALTH KNOWL20 EDGE AND AWARENESS OF ALZHEIMER’S DIS21 EASE, COGNITIVE DECLINE, AND BRAIN 

22 HEALTH UNDER THE ALZHEIMER’S DISEASE 

23 AND HEALTHY AGING PROGRAM. 

24 ‘‘(a) DEFINITIONS.—In the section: 


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1 ‘‘(1) ALZHEIMER’S DISEASE.—The term ‘Alz2 heimer’s disease’ means Alzheimer’s disease and re3 lated dementias. 

4 ‘‘(2) INDIAN TRIBE; TRIBAL ORGANIZATION.— 

5 The terms ‘Indian tribe’ and ‘tribal organization’ 

6 have the meanings given such terms in section 4 of 

7 the Indian Health Care Improvement Act. 

8 ‘‘(b) EXPANSION OF ACTIVITIES UNDER THE ALZ9 HEIMER’S DISEASE AND HEALTHY AGING PROGRAM.—In 

10 addition to activities conducted by the Secretary under the 

11 Alzheimer’s Disease and Healthy Aging Program of the 

12 Centers for Disease Control and Prevention, the Sec13 retary, acting through the Director of the Centers for Dis14 ease Control and Prevention, subject to appropriations 

15 under subsection (g), shall award cooperative agreements 

16 under subsections (c), (d), and (e). 

17 ‘‘(c) CENTERS OF EXCELLENCE IN PUBLIC HEALTH

18 PRACTICE.— 

19 ‘‘(1) IN GENERAL.—The Secretary shall award 

20 cooperative agreements to eligible entities for the es21 tablishment or support of national or regional cen22 ters of excellence in public health practice in Alz23 heimer’s disease to— 

24 ‘‘(A) advance the education of public 

25 health officials of States, of political subdiviVerDate Sep 11 2014 03:14 Nov 07, 2017 Jkt 079200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4256.IH H4256

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1 sions of States, and of Indian tribes or tribal 

2 organizations, health care professionals, and the 

3 public on Alzheimer’s disease, cognitive decline, 

4 brain health, and associated health disparities; 

5 ‘‘(B) advance the efforts of public health 

6 officials referred to in subparagraph (A) in ap7 plying evidence-based systems change, commu8 nications, and programmatic interventions for 

9 populations with cognitive impairment, includ10 ing Alzheimer’s disease, and caregivers for such 

11 populations; and 

12 ‘‘(C) expand public-private partnerships 

13 engaged in activities related to cognitive impair14 ment and associated health disparities with 

15 demonstrated success or innovative programs 

16 (as determined by the Secretary). 

17 ‘‘(2) REQUIREMENTS.—To be eligible to receive 

18 a cooperative agreement under this subsection, an 

19 entity shall submit to the Secretary an application 

20 containing such agreements and information as the 

21 Secretary may require, including an agreement that 

22 the center to be established or supported under the 

23 cooperative agreement will operate in accordance 

24 with the following: 


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1 ‘‘(A) The center will examine, evaluate, in2 crease, and promote evidence-based and effec3 tive Alzheimer’s disease and caregiving-related 

4 interventions for health and social services pro5 fessionals, underserved populations, families, 

6 and the public, after consultation with relevant 

7 State and local public health officials, private8 sector Alzheimer’s disease researchers, and ad9 vocates for individuals with Alzheimer’s disease. 

10 ‘‘(B) The center will prioritize its activities 

11 on the following: 

12 ‘‘(i) Expanding efforts to educate 

13 State, local, and tribal officials and public 

14 health professionals in applying established 

15 data and evidence-based best practices to 

16 address Alzheimer’s disease. 

17 ‘‘(ii) Supporting public health officials 

18 of States, of political subdivisions of 

19 States, and of Indian tribes or tribal orga20 nizations in implementing the most current 

21 version of the ‘Healthy Brain Initiative: 

22 Public Health Road Map’ of the Centers 

23 for Disease Control and Prevention. 

24 ‘‘(iii) Supporting early detection and 

25 diagnosis of Alzheimer’s disease. 


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1 ‘‘(iv) Reducing the risk of potentially 

2 avoidable hospitalizations of individuals 

3 with Alzheimer’s disease. 

4 ‘‘(v) Reducing the risk of cognitive de5 cline and cognitive impairment, including 

6 Alzheimer’s disease. 

7 ‘‘(vi) Enhancing support to meet the 

8 needs of caregivers of individuals with Alz9 heimer’s disease. 

10 ‘‘(vii) Reducing health disparities re11 lated to the care and support of individuals 

12 with cognitive decline and Alzheimer’s dis13 ease. 

14 ‘‘(viii) Supporting care planning and 

15 management for individuals with Alz16 heimer’s disease. 

17 ‘‘(3) CONSIDERATIONS.—In awarding coopera18 tive agreements under this subsection, the Secretary 

19 shall consider, among other factors, whether the en20 tity— 

21 ‘‘(A) has access to rural areas or other un22 derserved populations; 

23 ‘‘(B) is located in an area where the aggre24 gate success rate for applications for National 


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1 Institutes of Health funding has been histori2 cally low; 

3 ‘‘(C) is able to build on an existing infra4 structure of service and public health research; 

5 ‘‘(D) has experience with providing care, 

6 caregiver support, and research related to Alz7 heimer’s disease; and 

8 ‘‘(E) is integrated into existing local gov9 ernment and public health infrastructures. 

10 ‘‘(4) DISTRIBUTION OF AWARDS.—In awarding 

11 cooperative agreements under this subsection, the 

12 Secretary, to the extent practicable, shall ensure eq13 uitable distribution of awards based on geographic 

14 area, including consideration of rural areas, and the 

15 burden of the disease on sub-populations. 

16 ‘‘(d) COOPERATIVE AGREEMENTS TO PUBLIC

17 HEALTH DEPARTMENTS.— 

18 ‘‘(1) IN GENERAL.—The Secretary shall award 

19 cooperative agreements to health departments of 

20 States, of political subdivisions of States, and of In21 dian tribes and tribal organizations to promote cog22 nitive functioning, address cognitive impairment for 

23 individuals living in such communities, help meet the 

24 needs of caregivers, and address unique aspects of 

25 Alzheimer’s disease, as follows: 


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1 ‘‘(A) The Secretary shall award core ca2 pacity cooperative agreements to such health 

3 departments to support the development and 

4 implementation of systems change, communica5 tions, and programmatic interventions with re6 spect to Alzheimer’s disease, including activities 

7 involving— 

8 ‘‘(i) educating and informing the pub9 lic based on established public health re10 search and data; 

11 ‘‘(ii) supporting early detection and 

12 diagnosis; 

13 ‘‘(iii) reducing the risk of potentially 

14 avoidable hospitalizations; 

15 ‘‘(iv) reducing the risk of cognitive de16 cline and cognitive impairment; 

17 ‘‘(v) enhancing support to meet the 

18 needs of caregivers; 

19 ‘‘(vi) supporting care planning and 

20 management; or 

21 ‘‘(vii) supporting the actions set forth 

22 in the most current version of the ‘Healthy 

23 Brain Initiative: Public Health Road Map’ 

24 of the Centers for Disease Control and 

25 Prevention. 


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1 ‘‘(B) The Secretary shall award not less 

2 than 5 enhanced activity cooperative agree3 ments to such health departments to carry out 

4 activities related to Alzheimer’s disease, includ5 ing through public-private partnerships with or6 ganizations or other agencies, such as large em7 ployers, public housing agencies, large health 

8 care systems, and parks and recreation depart9 ments, that include— 

10 ‘‘(i) expanding implementation of pro11 grams described in paragraph (2)(A) to 

12 reach larger segments of the population; 

13 and 

14 ‘‘(ii) implementing the reports de15 scribed in subparagraph (A)(vii). 

16 ‘‘(2) OTHER CONSIDERATIONS.— 

17 ‘‘(A) PREFERENCE.—In awarding coopera18 tive agreements under paragraph (1), the Sec19 retary shall give preference to applications that 

20 focus on addressing health disparities, including 

21 populations and geographic areas that are most 

22 in need of intervention. 

23 ‘‘(B) CLARIFICATION ON ENHANCED AC24 TIVITY COOPERATIVE AGREEMENTS.—If the 

25 Secretary is unable to identify 5 eligible health 


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1 departments to receive a cooperative agreement 

2 under paragraph (1)(B), the Secretary shall al3 locate any amounts reserved for such agree4 ments to additional cooperative agreements 

5 under paragraph (1)(A). 

6 ‘‘(3) ELIGIBILITY.—To be eligible to receive a 

7 cooperative agreement under paragraph (1), a State, 

8 political subdivision of a State, Indian tribe, or tribal 

9 organization shall prepare and submit to the Sec10 retary an application at such time, in such manner, 

11 and containing such information as the Secretary 

12 may require, including a plan that describes— 

13 ‘‘(A) how the applicant proposes to develop 

14 or expand, programs to educate individuals 

15 through partnership engagement, workforce de16 velopment, guidance and support for pro17 grammatic efforts, strategic communication, 

18 and evaluation with respect to Alzheimer’s dis19 ease, and in the case of a cooperative agree20 ment under paragraph (1)(B), how the appli21 cant proposes to implement the most current 

22 version of the ‘Healthy Brain Initiative: Public 

23 Health Road Map’ of the Centers for Disease 

24 Control and Prevention; 


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1 ‘‘(B) the manner in which the applicant 

2 will coordinate with appropriate State and local 

3 authorities as well as, in the case of a coopera4 tive agreement under paragraph (1)(B), rel5 evant public and private organizations or agen6 cies; and 

7 ‘‘(C) the manner in which the applicant 

8 will evaluate the effectiveness of any program 

9 carried out under the cooperative agreement. 

10 ‘‘(4) USE OF FUNDS.—A health department 

11 awarded a cooperative agreement under paragraph 

12 (1) shall use amounts received under such coopera13 tive agreement to— 

14 ‘‘(A) develop, implement, disseminate, 

15 evaluate, and if applicable, expand programs to 

16 educate individuals on matters related to Alz17 heimer’s disease described in paragraph (1)(A); 

18 and 

19 ‘‘(B) in the case of a cooperative agree20 ment under paragraph (1)(B), implement the 

21 most current version of the ‘Healthy Brain Ini22 tiative: Public Health Road Map’ of the Centers 

23 for Disease Control and Prevention and evalu24 ate its implementation. 

25 ‘‘(5) MATCHING REQUIREMENT.— 


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1 ‘‘(A) IN GENERAL.—Except as may be pro2 vided in subparagraph (B), each health depart3 ment that is awarded a cooperative agreement 

4 under paragraph (1) shall provide, from non5 Federal sources, an amount equal to 15 percent 

6 of the amount provided under such agreement 

7 (which may be provided in cash or in-kind) to 

8 carry out the activities supported by the cooper9 ative agreement. 

10 ‘‘(B) WAIVER AUTHORITY.—The Secretary 

11 may waive all or part of the matching require12 ment described in subparagraph (A) for any fis13 cal year for— 

14 ‘‘(i) a health department, if the Sec15 retary determines that applying such 

16 matching requirement to the health depart17 ment would result in serious hardship or 

18 an inability to carry out the purposes of 

19 the cooperative agreement awarded to such 

20 health department; or 

21 ‘‘(ii) a rural or frontier region. 

22 ‘‘(e) COOPERATIVE AGREEMENTS FOR ANALYSIS AND

23 REPORTING OF DATA REGARDING COGNITIVE DECLINE

24 AND CAREGIVING.— 


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1 ‘‘(1) IN GENERAL.—The Secretary may award 

2 cooperative agreements to eligible entities for the fol3 lowing activities: 

4 ‘‘(A) The analysis and timely public re5 porting of data on the State and national levels 

6 regarding cognitive decline, including Alz7 heimer’s disease, caregiving, and health dispari8 ties experienced by individuals with cognitive 

9 decline and their caregivers. 

10 ‘‘(B) The monitoring of objectives on de11 mentia, including Alzheimer’s disease, and 

12 caregiving in the program of the Secretary re13 garding health-status goals for 2020 (commonly 

14 referred to as the ‘Healthy People 2020 re15 port’), and the development and monitoring of 

16 such objectives in future Healthy People reports 

17 of the Department of Health and Human Serv18 ices. 

19 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

20 cooperative agreement under this subsection, an en21 tity shall be a public or nonprofit private entity, in22 cluding institutions of higher education, and submit 

23 to the Secretary an application at such time, in such 

24 manner, and containing such information as the Sec25 retary may require. 


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1 ‘‘(3) SURVEILLANCE.—The analysis, timely 

2 public reporting, and dissemination of data regard3 ing cognitive decline, cognitive impairment, caregiv4 ing, and health disparities on the State and national 

5 levels under a cooperative agreement under this sub6 section may be carried out by eligible entities using 

7 data sources such as the following: 

8 ‘‘(A) The Behavioral Risk Factor Surveil9 lance System. 

10 ‘‘(B) The National Health and Nutrition 

11 Examination Survey. 

12 ‘‘(C) The National Health Interview Sur13 vey. 

14 ‘‘(f) DATA COLLECTION.—The Secretary shall collect 

15 data on cognitive decline, cognitive impairment, caregiv16 ing, and health disparities on the State and national levels, 

17 using the surveillance systems described in subparagraphs 

18 (A) through (C) of subsection (e)(3). 

19 ‘‘(g) NONDUPLICATION OF EFFORT.—The Secretary 

20 shall ensure that activities under any cooperative agree21 ment awarded under this section do not unnecessarily du22 plicate efforts of other agencies and offices within the De23 partment of Health and Human Services related to— 


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1 ‘‘(1) activities of centers of excellence in public 

2 health practice with respect to Alzheimer’s disease 

3 described in subsection (c); 

4 ‘‘(2) activities of public health departments with 

5 respect to Alzheimer’s disease described in sub6 section (d); or 

7 ‘‘(3) the analysis and public reporting of sur8 veillance data on cognitive decline, caregiving, and 

9 health disparities of individuals with Alzheimer’s dis10 ease under subsection (e). 

11 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For 

12 each of fiscal years 2018 through 2025, there are author13 ized to be appropriated $12,000,000 for purposes of car14 rying out subsection (c), $20,000,000 for purposes of car15 rying out subsection (d), and $5,000,000 for purposes of 

16 carrying out subsections (e) and (f). Funds appropriated 

17 under this subsection shall remain available until ex18 pended.’’. 

Æ 


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